11D0973727 CLIA NUMBER - OAKS AT LAKE WILDWOOD

Laboratory Demographics

CLIA Number: 11D0973727

Facility Name: OAKS AT LAKE WILDWOOD

Facility Address:
6191 PEAKE ROAD
MACON, GA
ZIP 31220
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Facility Phone Number: 478 477-6911

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1033484928

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	11D0973727
LAB Type	Assisted Living Facility
Facility Name	OAKS AT LAKE WILDWOOD
Street	6191 PEAKE ROAD
City	MACON
State	GA
ZIP	31220
Phone	478 477-6911
CertificateType	4
CertificateEffectiveDate	4/11/2023
CertificateExpirationDate	4/10/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024